To investigate the effects of female age and serum basal follicle stimulating hormone (FSH) levels on pregnancy outcome of artificial insemination with husbands sperm (AIH).

From January 2012 to December 2016, a total of 1 835 cycles of 885 infertile women who received AIH treatment at the Reproductive Medicine Center of the Northern Jiangsu People′s Hospital were included in the study, including 738 ovulation induction cycles and 1 097 natural cycles. According to the age of the subjects, 1 835 treatment cycles were divided into <35 years old group (n=1 621) and ≥35 years old group (n=214). In addition, according to the serum basal FSH level of the subjects, the treatment cycles were divided into FSH<10 IU/L group (n=1 632) and FSH≥10 IU/L group (n=203). The clinical cases data of the subjects were retrospectively analyzed. The t test and chi-square test were used to compare the general clinical data between two groups of subjects with different ages or different serum basal FSH levels, such as infertility years, body mass index (BMI), serum estradiol concentration and endometrial thickness at transplantation day, etc., as well as AIH pregnancy outcomes including clinical pregnancy rate and spontaneous abortion rate. This study was in line with World Medical Association Declaration of Helsinki revised in 2013, and all subjects obtained informed consents.

① The clinical pregnancy rate of AIH in infertile women in <35 years old group was 13.6% (221/1 621), which was significantly higher than that of 8.4% (18/214) in age ≥35 years old group; the spontaneous abortion rate of AIH in age <35 years old group was 14.0% (31/221), which was significantly lower than that of 44.4% (8/18) in age ≥35 years old group, and the differences were statistically significant (χ²=5.483, 11.277; P=0.019, 0.001). ② The clinical pregnancy rates of AIH in serum basal FSH<10 IU/L group and ≥10 IU/L group were 13.4% (218/1 632) and 9.9% (20/203), respectively, and there was no significant difference between two groups in clinical pregnancy rate (P>0.05). The spontaneous abortion rate of AIH in serum basal FSH<10 IU/L group was 14.2% (31/218), which was significantly lower than that of 40.0% (8/20) in serum basal FSH ≥10 IU/L group, and the difference was statistically significant (χ²=8.964, P=0.003). ③ For infertile women with serum basal FSH <10 IU/L, the clinical pregnancy rate of AIH with ovulation induction cycles was 15.6% (100/639), which was significantly higher than that of 11.9% (118/993) with natural cycles, and the difference was statistically significant (χ²=4.765, P=0.029). For infertile women of age <35 years old, or age ≥35 years old, or serum basal FSH ≥10 IU/L, there were no significant differences between ovulation induction cycles and natural cycles in AIH clinical pregnancy rate (P>0.05).

The older the infertile woman is, or the higher the serum basal FSH level is, the lower the clinical pregnancy rate of AIH and the higher the spontaneous abortion rate are. For the infertile women with advanced age (≥35 years old) or high serum basal FSH levels (≥10 IU/L), the clinical pregnancy rate of AIH cannot be improved with ovulation induction cycle. For infertile women with serum basal FSH <10 IU/L, adoption of ovulation induction cycle measures may increase the clinical pregnancy rate of AIH.